Protocol for Psychosocial Rehabilitation of COVID-19 Patients for BNYS Doctors

Naturopathy Intervention for COVID 19 & Assessment of Psychosocial Issues in COVID19 Patients

Dr. Apar Avinash Saoji, B.N.Y.S, PhD (Yoga) Principal, The School of Yoga & Naturopathic Medicine S-VYASA, Bengaluru and Dr. Swathi P. S., B.N.Y.S, PhD Scholar Asst. Professor, The School of Yoga & Naturopathic Medicine S-VYASA, Bengaluru Module 3: Naturopathy Intervention for COVID 19 Duration of the training session: 90 min Session Objective: • To educate the participants about understanding and administration of Naturopathy interventions for COVID 19 patients Objectives for Naturopathy Interventions for COVID 19 • To enhance quality of life • To reduce possibility of proliferation of virus and give symptomatic relief • To modulate immune response for Corona virus Why Naturopathy Interventions?

• Simple, cost-effective treatments and lifestyle measures that can be adapted easily • Participants can self-administer most of the therapies • If participants are unable to administer: assistance can be provided Naturopathy interventions

Steam inhalation Hot foot immersion Gargling Aromatherapy and Massage therapy Acupressure Heliotherapy Naturopathic Diet Steam inhalation

• To reduce viral load, reduce upper respiratory symptoms • Plain water or add tulasi leaves/eucalyptus or peppermint oil • Duration: 2-5 minutes/twice a day Hot Foot Immersion:

• Objective: To improve sleep, reduce respiratory symptoms • Procedure: Place both the legs up to mid- calf inside the bucket of hot water for 10-15 min. • Duration: 10-15 min/ once or twice a day Gargling

• Use warm saline water • Duration: 5 min/ twice a day (if symptomatic like sore throat – can be practiced more times) Aromatherapy + Massage Therapy:

Essential Oils: Eucalyptus/Peppermint/Thyme Mixed with Base oil: coconut/mustard/gingelly Procedure: Self Massage to chest and upper back Duration: 10-15 min/ once a day Sniffing: Apply 1-2 drops of mentioned essential oil drops in a handkerchief and sniff it for 6 times in a day Acupressure

• To confer immunity and improve respiratory effort • Intermittent pressure over acupressure points LI-4, LI11, SP6, TW 5, CV17, ST36 • Pressure should be applied till the participant has comfortable or tolerable level of pain • Duration: 5-10 min/day Heliotherapy (Sun Bath)

• Sun exposure for 15-20 minutes daily may help boost immunity • Production of adequate amount of Vitamin D • Vitamin D has protective effect in COVID19 Naturopathy therapies as a lifestyle measure • Naturopathy therapies should become a part of daily routine. • This can be easily achieved by following some simple tips: • Gargling can be performed along with brushing the teeth • Chest and back massage, acupressure and hot foot immersion can be done just before going for bath Naturopathic Nutritional Immune Boosters

Natural Immune Boosting by Herbal Decoction • Indian Gooseberry Juice 50ml, • Tulsi (Basil) juice 50 ml, • Ginger juice 10ml, • Fresh Lime Juice 5ml, • Turmeric Powder ¼ Tsp, and Drinking Water 150 ml. • Strain and drink it hot. Dose: Adult: 250ml twice a day, Children: 100ml twice a day Natural Immune Boosting Hot Drink

All the below should be boiled till the raw smell goes away • Peeled Crushed Ginger 5 gm, • Tulsi (Basil) leaves 10 gms, • Freshly crushed black pepper ¼ tsp, • Crushed Adhimaduram 5gms (liquorice root), • Turmeric powder ¼ tsp and drinking water 250ml • To strain and drink it hot. • Dose: Adult: 50 ml twice a day, Children: 20 ml twice a day Naturopathic Nutrition

• Seasonal and Regional variations • Bland (non-irritant), Sattvic, fresh vegetarian food • Balanced diet giving optimal nutrition • Rich in phytochemicals Module 4: Assessment of Psychosocial Issues in Covid 19 Patients Assessments

Duration of the training session: 60 min Session Objective: • To educate the participants about administration and interpretation of various assessment tools for COVID 19 patients Objectives of the assessments: • To understand the psychosocial issues of patients COVID19 • To understand the changes associated with Yoga, Naturopathy and Psychosocial rehabilitation modalities Assessments for COVID19 patients

• To be assessed at baseline, 10th day and 30th day • All assessment tools: self-assessed by the patients • Caregivers to provide help for assessment if need be

• Total duration needed for the assessments: approx. 30 min Assessments for COVID19 patients

• Self-rated symptom assessment checklist • Perceived stress scale (PSS) • Yoga performance assessment (YPA) • Generalized Anxiety Disorder – 7 (GAD 7) • Patient Health Questionnaire -9 (PHQ 9) • WHO Well-being index Self-rated symptom assessment checklist

• 15 items (symptoms) with 5-point Likert scale for the severity

• Symptoms include: Fever, Sore Throat, Cough, Running Nose, Shortness of Breath, Chills, Vomiting, Nausea, Diarrhea, Headache, Rashes, Muscle/joint aches, Loss of appetite, Loss of smell, Fatigue

• An average score will calculated to understand the disease severity and prognosis Perceived Stress Scale (PSS)

• 10 item scale assessing the thoughts and feelings of the individual on a 5 point Likert scale • Six items need reverse scoring and four non-reverse scoring • Total scores need to be summed up • Interpretation: • 0-13: Low stress • 14-26: Moderate stress • 27-40: High perceived stress Yoga performance assessment (YPA)

• Eight questions to be answered on 4 point scale • To assess the participant’s ability to follow instructions and perform the yoga practices as instructed • Also gives the information about weather the participant needs assistance for performing yoga practices • Higher score indicate better performance Generalized Anxiety Disorder – 7 (GAD 7)

• Assesses anxiety • 7 item scale with a feeling being present “not at all” to “nearly every day” • Higher scores indicate higher levels of anxiety Patient Health Questionnaire -9 (PHQ 9)

• 9 item scale to assess overall health of an individual • Rating the problem being “not at all” to “every day” • Higher scores indicate deterioration in health WHO well being index

• Assesses overall well being • 5 questions with answers ranging from “All the time” to “at no time” as options • Higher scores indicate better well-being • Scores lower than 13 indicate poor well-being as well as depression Thank you!!!

Dr. Apar Avinash Saoji Principal The School of Yoga and Naturopathic Medicine S-VYASA, Bengaluru [email protected]